Many Diabetes Patients Wear the Wrong Shoes

From WebMD Health News

Kathleen Doheny

April 22, 2011 — Many patients with diabetes fall short on foot care and footwear, according to a new study.

Failure to perform recommended foot care and wearing inappropriate footwear can set diabetes patients up for foot ulcers. Ulcers are painful and potentially serious. They can sometimes lead to amputation.

Most diabetes patients polled for the study said they know proper foot care and properly fitting shoes are important. But they don't always follow through, according to Stephen Ogedengbe, MD, a researcher at the University of Benin Teaching Hospital in Benin City, Nigeria.

He presented the study at the American Association of Clinical Endocrinologists' meeting in San Diego.

''There is no such thing as perfect footwear for persons with diabetes mellitus," he tells WebMD. "However, there are shoes which can help prevent or delay the onset of foot ulceration in diabetes. There are also shoes which can cause or help accelerate the development of foot ulceration."

Survey on Diabetes Footwear

The study was conducted in Lagos, Nigeria. Ogedengbe and colleagues asked 41 patients with type 2 diabetes, on average about 57 years old, to answer questions about their footwear habits and foot care.

The researchers found some good news:

* 90% had education about footwear
* 83% wash and dry their feet, a practice recommended daily
* 51% do the recommended routine self-exams of their feet

However, about 56% told the researchers they always or occasionally walk around the house without shoes, which is not recommended. Nearly 15% did so outside, too.

Next, researchers evaluated the participants' shoes. They found 68% of the footwear to be inappropriate.

Among the shoes that didn't pass muster, Ogedengbe says, are:
* Shoes with pointed tips or toes
* High heels
* Thong-style sandals or flip-flops
Besides inappropriate shoe styles, he tells WebMD, some wore shoes that were the wrong size.
Despite these flaws in shoe wear, 73% of the patients thought their inappropriate footwear was acceptable.

Here are Ogedengbe's tips for finding proper footwear.
* Avoid shoes with pointed toes.
* Don't buy shoes with too flat a sole or high heels because they don’t allow for even distribution of foot pressure.
* Look for styles that have soft insoles.
* Choose leather, canvas, or suede styles to allow adequate circulation of air. Don't buy plastic or other materials that don't allow the shoe to ''breathe."
* Look for such features as laces, buckles, or Velcro. These make it easier to adjust the shoe.

Second Opinion

''The study [result] doesn't surprise me," says David G. Armstrong, DPM, MD, PhD, professor of surgery and director of the Southern Arizona Limb Salvage Alliance at the University of Arizona College of Medicine, Tucson.

He reviewed the findings for WebMD but was not involved in the research. He serves on the scientific advisory board for Vasyli, a manufacturer of orthotics.

The study confirms what Armstrong observes with some patients, he tells WebMD. "The doctor and nurse can tell the patient something [about proper footwear]. Just because we tell them doesn’t mean they are going to be motivated to make changes."

What may help, he says, is to let those with diabetes know that the risk of foot ulcers is as high as 25%, according to the American Diabetes Association.

Wearing properly fitted shoes can help reduce that risk, Armstrong says. "The problem here is the neuropathy is silent," he says. With nerve damage in the feet, there is a loss of feeling in the feet.

Get an evaluation by a foot doctor every year, Armstrong says. "Doing that alone, just seeing the podiatrist, reduces your risk of getting a wound and then getting amputation by anywhere from 20% to 70%."

Proper shoes don't have to look like ''Frankenstein shoes," he says. He differs with Ogedengbe in that he does allow women with diabetes to wear heels, within reason.